Two characteristic elements of the acute-phase response are an altered pattern of circulating hepatic proteins and fever. Whereas a fever-induced heat shock response could affect expression of acute-phase proteins in the liver, the effects of a modest temperature increase on protein secretion in interleukin-6 (IL-6)-stimulated HepG2 cells were investigated. The response of HepG2 cells to IL-6 stimulation was significantly affected by heat treatment at 40ЊC. Albumin secretion rates, which were reduced by a factor of 2 in response to either heat shock or IL-6 stimulation alone, were down-regulated by a factor of 4 when IL-6 was administered simultaneously with a continuous 40ЊC heat shock. IL-6-induced fibrinogen up-regulation was significantly reduced by heat treatment (P F .01), and secretion rates were indistinguishable from control levels after 2 days (P G .10). Unexpectedly, heat shock at 40ЊC induced a fivefold up-regulation of haptoglobin production in the absence of IL-6. Simultaneous heat shock and IL-6 stimulation caused a synergistic enhancement of haptoglobin expression, with secretion rates increasing up to 30-fold compared with unstimulated control cells. For all three proteins, the interaction between temperature and IL-6 concentration was statistically significant (P F .001). Heat treatment resulted in significant alterations of both the kinetics and sensitivity of IL-6-induced protein synthesis, suggesting a major modification of the mechanism of acute-phase protein regulation at 40ЊC. In summary, the data show that heat shock can significantly modulate the pattern of acute-phase protein expression and that fever may be an important regulatory factor in the acute-phase response. (HEPATOLOGY 1998;28:994-1004.)The acute-phase response, a collective term referring to the constellation of host defense mechanisms induced in response to inflammation, infection, trauma, and certain malignancies, is characterized by drastic metabolic changes in the liver and is often accompanied by fever in the host. Indeed, the same cytokines that mediate the inflammatory processes are also endogenous pyrogens.